Actinic Keratoses are considered precancerous lesions which, if left untreated, can become squamous cell carcinoma or basal cell carcinoma. Actinic keratoses are small, scaly lesions that are found in sun exposed areas. These lesions tend to form in groups and it is not uncommon to find 10 or 15 on the backs of the hands, face or top of the scalp. It is commonly believed that the ultraviolet radiation from the sun causes damage to the skin cells. Once the damaged cells proliferate, they form scaly bumps known as actinic keratoses. Under the microscope, actinic keratoses appear to be mini squamous cell carcinomas. The lesions vary in color from beige to red to pink, and patients often complain of itching or irritation at the site of an actinic keratosis. Dr. Goldenberg is an expert in diagnosis and treatment of actinic keratosis. Dr. Goldenberg has given numerous lectures at national meetings and is currently studying actinic keratosis to improve diagnosis and treatment of these lesions.
Cryosurgery is the most commonly used treatment of actinic keratosis and is performed with an instrument that freezes and destroys abnormal tissue. The simplest lesion removal treatment involves the application of liquid nitrogen using a sprayer or applicator at the site. There is typically some blistering which removes the damaged cells, allowing new skin to replace it.
When there are numerous actinic keratoses, Dr Goldenberg may prescribe a topical cream to treat the visible lesions as well as the lesions under the surface. The most common topical treatment for actinic keratoses involves application of an immune modulator (stimulates local immune system) imiquimod, a topical chemotherapy know as 5 fluorouracil, or a new product called Picato. Zyclara, the brand name imiquimod, is now available in a pump – this makes the product easy to use. Picato is the newest AK treatment approved by the FDA. The treatment course with Picato is short, with 3 total applications for the face and scalp and 2 total applications for the hands, forearms and chest. Topical treatment usually produces redness of the skin, so discuss your social schedule with Dr. Goldenberg before starting this treatment.
Dr. Goldenberg recently performed two large studies on the combination treatment of actinic keratosis. The studies showed that patients who used a combination therapy of cryotherapy and topical cream for actinic keratosis, had a higher cure rate than those patient who used cryotherapy alone. Dr. Goldenberg may ask you to use both treatment modalities if you have a high number of precancerous actninc keratosis.
Photodynamic blue light therapy (PDT) is a non-invasive method used to treat photo damage, precancerous lesions and other skin conditions. A special light-sensitive medication called AminoLevulinic Acid (ALA) is applied to the skin affected by actinic keratosis and allowed to remain there. Then the blue light is directed to the skin and the cells that have absorbed the medication respond. The application of ALA followed by the exposure of specific blue light causes the selective destruction of targeted cells. Many patients can achieve excellent results with a course of treatments using ALA and blue light.
With this method, Dr. Goldenberg uses a curette (a rounded metal object with a sharp edge) to scrape out the actinic keratosis. Electrical current is then used to burn (electrodesiccate) the base of the lesion. This process is repeated three times to obtain a margin around the actinic keratosis.